Abstract of Dissertation

Keyword : VHND; Village Health and Nutrition Day; ANM; Auxiliary Nurse Midwife; AWW; Anganwadi workers

Objective : ï‚· To quantify the availability of logistics in the VHND. ï‚· To assess the effectiveness of service delivery at VHND sessions.

Background : Village Health and Nutrition Day, introduced by National Rural Health Mission is an initiative to improve maternal, new born, child health and nutrition in rural areas. All over India VHNDs are held once in a month in every village at the Anganwadi centre. VHNDs are held on a predetermined time, place and day. VHNDs provide health and nutritional services along with counselling on nutrition, contraception, family planning, complete immunisation, sanitation and hygiene. Anganwadi workers (AWWs) and Accredited Social Health Activists (ASHAs) bring the villagers to the Anganwadi centre with the help of Panchayati Raj Institutional members. The task of Auxiliary Nurse Midwife (ANMs) is to provide ante-natal care and immunizations. AWWs monitor growth of children and refer children with severe malnutrition to the nearest public health facility. Apart from it, supplementary nutrition is also provided. All the three frontline members (ANM, ASHA, and AWW) are important for the proper functioning of VHND.(1)

Methodology : Study Design: cross sectional Descriptive study Study Location: purposively selected 4 TSU blocks from district Faizabad (where IHAT is going to start the project Nutrition), Uttar Pradesh. Sampling: simple Random sampling (where India Health Action Trust is going to implement Nutrition project) Sample size: 4 Technical Support Unit blocks were selected. Each block is divided into 3 – 4 clusters. 8 villages were selected randomly from each cluster to observe the VHND session Total no. of clusters = 13 No. of villages from each cluster = 8 Total no. of VHND sites =104 Sample size = 104 Non-response rate = 12 (due to trainings conducted by IHAT) Study Duration: 3 months (22nd February to 10th May) Data Collection Tool: VHND Assessment Tool Method of data collection: The methodology adopted was: 1. Participant observation 2. Site observation.

Findings : Total number of VHND sites assessed were 92. Out of 92 sessions, only 80 sessions were Held as per micro plan. Out of total sessions, only 16.3 percent were held in AWCs, 26 Percent held in sub centres, schools and PRIs and 57 percent sessions held at someone’s residence. Around all the sessions observed percentage of ASHAs and AWWs present was 94 percent and 92 percent respectively. On an average, only 24 percent VHNDs had toilet facility available. Sixty percent VHNDs held at AWCs had toilet facility whereas only 36 percent of VHNDs held at someone’s residence had toilets available which is very less as most of the VHNDs were held at someone’s residence i.e. 57 percent. Privacy for ANC was around 80 percent and 92 percent at AWCs and government institutions respectively and only 60 percent at someone’s residence. Availability of adult weighing machine was around 92 percent overall. Availability of child weighing machines in VHNDs constituted around 62 percent. Only 50 percent of VHNDs held at government institutions had the weighing machine available. Due list prepared for nutrition services were only 53 percent in AWCs, 75 percent in schools and PRIs and 66 percent at someone’s residence. On an average, only 79 percent of birth planning prepared by ASHA was reviewed by ANM and around only 69 percent was reviewed by ANM when VHNDs were conducted at someone’s residence and 92 percent VHNDs held at Government institutions where such where ANMs reviewed the birth planning prepared by ASHA. Out of the total VHNDs assessed, only 58 percent sessions where such where ANM has prepared line listing of High Risk Pregnancies. Line listing of HRPs at AWCs was 80 percent. Sixty three percent listing of HRPs at sessions held at other government institutions and only 49 percent sessions held at someone’s residence were such where ANM had prepared the line listing of pregnancies.

Recommendations : ï‚· Supervisory visit to ensure proper weighing and plotting on the spot. ï‚· Agenda based sector meeting focusing on the progress of weighing of 0-3/3-5 years ï‚· Ensure follow up of referral children by supervisory visit. Assessment of quality services through concurrent monitoring